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Nosocomial Pneumonia on General Medical and Surgical Wards in a Tertiary-Care Hospital

Published online by Cambridge University Press:  02 January 2015

Christina A. Greenaway ,
John Embil ,
Pamela H. Orr ,
Judith McLeod ,
Brenda Dyck  and
Lindsay E. Nicolle
Christina A. Greenaway
Affiliation:
Section of Infectous Diseases, Department of Internal Medicine, Winnipeg, Manitoba, Canada Departments of Medical Microbiology, Winnipeg, Manitoba, Canada
John Embil
Affiliation:
Section of Infectous Diseases, Department of Internal Medicine, Winnipeg, Manitoba, Canada Departments of Medical Microbiology, Winnipeg, Manitoba, Canada
Pamela H. Orr
Affiliation:
Section of Infectous Diseases, Department of Internal Medicine, Winnipeg, Manitoba, Canada Departments of Medical Microbiology, Winnipeg, Manitoba, Canada Community Health Sciences, University of Manitoba, Health Sciences Center, Winnipeg, Manitoba, Canada
Judith McLeod
Affiliation:
University of Manitoba, Health Sciences Center, Winnipeg, Manitoba, Canada
Brenda Dyck
Affiliation:
Community Health Sciences, University of Manitoba, Health Sciences Center, Winnipeg, Manitoba, Canada University of Manitoba, Health Sciences Center, Winnipeg, Manitoba, Canada
Lindsay E. Nicolle*
Affiliation:
Section of Infectous Diseases, Department of Internal Medicine, Winnipeg, Manitoba, Canada Departments of Medical Microbiology, Winnipeg, Manitoba, Canada
*
GC 430, Health Sciences Center, 820 Sherbrook St, Winnipeg, Manitoba R3A 1R9, Canada
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Abstract

Objective:

To describe the demographic, clinical, and microbiologic characteristics of patients who develop nosocomial pneumonia on general medical and surgical wards of a tertiary-care hospital.

Design:

A one-year, prospective, descriptive study.

Setting:

a 1,100-bed, tertiary-care, urban hospital.

Population:

Patients experiencing nosocomial pneumonia were identified through surveillance on general medical and surgical wards, using a standard case definition.

Results:

92 pneumonias in 85 patients on general wards were identified. The mean age of patients was 63 ±? 17 years, 55 patients (65%) were male, and 75 cases of pneumonia (81%) were acquired on surgical wards. Bacteremia was identified in 8 (13%) of 62 episodes, and 48 (52%) grew potential pathogens from respiratory specimens. Twenty-six patients (28%) required transfer to the intensive-care unit (ICU), and 20 (22%) received mechanical ventilation. By multivariate analysis, patients with a thoracic surgical procedure or with Staphylococcus aureus isolated from respiratory secretions were more likely to require ICU admission. The overall mortality rate was 20% (17/85), with a directly associated mortality of 14% (12/85). Patients who died were older, more frequently resided on a medical ward, and had a greater mean number of comorbidities. These patients often were treated nonaggressively and were not considered candidates for ICU admission due to advanced age and poor underlying clinical status.

Conclusions:

Although the morbidity of nosocomial pneumonia in this population was high, as evidenced by high rates of transfer to ICU, the directly associated mortality was relatively low. Those requiring ICU admission require further study to identify preventive measures that could decrease the morbidity in this group. Interventions to prevent pneumonia or to improve prognosis may not be feasible for the majority of these patients who die from nosocomial pneumonia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 11 , November 1997 , pp. 749 - 756
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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